舒筋活络方治疗创伤性膝关节粘连实验研究

目的：比较地塞米松肌注、舒筋活络方热敷及配合关节松动3种不同干预措施对创伤性膝关节粘连模型兔膝关节活动度、粘连程度及胶原蛋白浓度的影响。方法：新西兰成年雄性家兔60只,随机分为5组（n=12）,即空白对照组、模型组、地塞米松治疗组、舒筋活络方热敷组、舒筋活络方热敷加关节松动组。除对照组外,其余48只家兔实施手术,建立创伤性膝关节粘连（TAK）模型,经不同干预措施处理3周及6周后,分析各组膝关节活动度、粘连程度及关节滑膜组织的胶原蛋白浓度。结果：膝关节活动度：治疗6周后,空白对照组的关节活动度明显大于模型组,差异有非常显著性意义（P〈0.001）;3个治疗组的关节活动度也大于与模型组,差异显著（P〈0.01）。膝关节粘连评分：治疗3周后,模型组的膝关节粘连程度明显高于其余4组,差异有非常显著性意义（P〈0.01）;地塞米松组、舒筋活络方热敷加关节松动组均低于舒筋活络方热敷组,差异有显著性意义（P〈0.05）。治疗6周后,其余4组膝关节粘连程度与模型组比较,差异均有非常显著性意义（P〈0.01）;舒筋活络方热敷组的膝关节粘连程度低于其余2个治疗组（P〈0.05）,但高于空白对照组（P〈0.01）。胶原蛋白浓度：治疗3周后,模型组滑膜组织I型胶原蛋白浓度明显高于其余4组,差异有显著性或非常显著性意义（P〈0.05,P〈0.01）;与空白对照组比较,各治疗组I型胶原蛋白浓度明显高于空白对照组,差异有显著性意义（P〈0.05）。模型组Ⅲ型胶原蛋白浓度明显高于其余4组,差异均有显著性意义（P〈0.01）;其中,3个治疗组的Ⅲ型胶原蛋白浓度高于空白对照组,差异显著（P〈0.05）。与空白对照组比较,其余各组的Ⅲ型/（I＋Ⅲ）型比值均较高,差异有显著性意义（P〈0.05）。治疗6周后,模型组滑膜组织I型胶原蛋白浓度增高更显著,与其余4组比较,差异有显著性或非常显著性意义（P〈0.05,P〈0.01）;与空白对照组比较,地塞米松组、舒筋活络方热敷加关节松动组I型胶原蛋白浓度较高,差异有显著性意义（P〈0.01）。与舒筋活络方热敷组比较,地塞米松组I型胶原蛋白浓度较高,差异有显著性意义（P〈0.05）。舒筋活络方热敷组、空白对照组Ⅲ型胶原蛋白浓度均低于模型组,差异也有显著性意义（P〈0.05）。其余各组的Ⅲ型（/I＋Ⅲ）型比值与模型组比较,明显高于模型组,差异有显著性意义（P〈0.05）。结论：舒筋活络方热敷与肌注地塞米松均可抑制关节滑膜组织中胶原蛋白的合成,明显减轻创伤性膝关节粘连的程度,降低关节粘连强度,改善关节活动度,但从长期疗效看,舒筋活络方的作用优于地塞米松。

Experimental Study of Chinese Herb Shujin Huoluo on Traumatic Adhesion of Knee

Objective：To observe the effects of three kinds of therapy：intramuscular injection of dexamethasone,hot wash with Chinese herb Shujin Huoluo combined with or without joint movement on rabbits of traumatic adhesion of knee.Method：60 Zelanian mature male rabbits were divided into 5 groups randomly（n=12）：normal control group,model group,group treated by dexamethasone injection,group treated by hot wash with Chinese herb Shujin Huoluo,group treated by hot wash with Chinese herb Shujin Huoluo combined with joint movement.48 rabbits were performed operation to induce adhesion of knee except the rabbits in normal control group.ROM of knee,degree of adhesion,concentration of collagen protein in the affected tissue were detected respectively after 3 weeks’ and 6 weeks’ treatment.Result：ROM of knee：After 6 weeks’ treatment,ROM of knee of the rabbits in normal control group was significantly larger than that in model group（P〈0.001）;and ROM of knee in the three treatment groups were all significantly larger than that in model group（P〈0.01）.Score of adhesion of knee：After 3 weeks’ treatment,score of adhesion of knee of the rabbits in model group was significantly higher than score of the other four groups（P〈0.01）;Score of dexamethasone group and Score of Shujin Huoluo combined with joint movement group were significantly lower than score of Shujin Huoluo group（P〈0.05）.After 6 weeks’ treatment,degree of adhesion of model group was obviously different from that of the other four groups（P〈0.01）in which degree of adhesion of Shujin Huoluo group was obviously lower than that of the other two treatment groups（P〈0.05）but highter than that of control group（P〈0.01）.Concentration of collagen protein：After 3 weeks’ treatment,concentration of I-type collagen protein in the synovial tissue of model group was obviously higher than that of the other four groups（P〈0.05,P〈0.01）;and concentration of I-type collagen protein of the three treatment group was obviously higher than that of normal control group（P〈0.05）.Concentration of Ⅲ-type collagen protein of model group was obviously higher than that of the other four groups（P〈0.01）;and concentration ofⅢ-type collagen protein of the three treatment groups was significantly higher than that of normal control group（P〈0.05）.Ratio of Ⅲ/（I＋Ⅲ）of normal control group was significantly lower than that of other groups（P〈0.05）.After 6 weeks’ treatment,concentration of I-type collagen protein in the synovial tissue of model group was much higher that of the other four groups（P〈0.05,P〈0.01）;and concentration of I-type collagen protein of dexamethasone group and that of Shujin Huoluo combined with joint movement group was obviously higher than that of normal control group（P〈0.01）.Concentration of I-type collagen protein of dexamethasone group was higher than that of Shujin Huoluo group（P〈0.05）.Concentration of Ⅲ-type collagen protein of model group was significantly higher than that of Shujin Huoluo group and normal control group（P〈0.05）.Ratio ofⅢ/（I＋Ⅲ）of model group was significantly lower than that of other groups（P〈0.05）.Conclusion：Shujin Huoluo and dexamethasone can both inhibit synthesis of collagen protein in synovial tissue of the affected knee,then reduce the degree and stiffness of traumatic adhesion of knee,improve the ROM of knee,but the long-term effect of Shujin Huoluo is better than dexamethasone.